Vitamin D status in children with leukemia, its predictors, and association with outcome

Abstract

Background Children and adolescents with leukemia are potentially at high risk of vitamin D inadequacy, which may have clinical relevance for skeletal morbidity, infections, and cancer outcome. This study aimed to evaluate vitamin D status at the time of diagnosis to investigate its predictors and association with overall survival in children with leukemia. Procedure We included all 295 children and adolescents diagnosed with leukemia at our institution between 1990 and 2016 who had available serum sample from the time of diagnosis. We analyzed serum 25‐hydroxyvitamin D and parathyroid hormone levels and correlated them with clinical data. Results The 25‐hydroxyvitamin D level was deficient (< 25 nmol/L), insufficient (25‐50 nmol/L), sufficient (50‐75 nmol/L), and optimal (> 75 nmol/L) in 6.4%, 26.8%, 39.7%, and 27.1% of the children, respectively. Older age and a more recent time of sampling (calendar year) predicted lower 25‐hydroxyvitamin D level. In preschool children (age ≤6 years), lower 25‐hydroxyvitamin D level was also associated with acute myeloid leukemia, and a 25‐hydroxyvitamin D level < 50 nmol/L was associated with inferior overall survival. In school‐aged children (age > 6 years), the 25‐hydroxyvitamin D level showed significant seasonal variation. Conclusion It remains unclear whether vitamin D supplementation in pediatric leukemia patients will improve outcome.

Prevalence of and factors influencing vitamin D deficiency in paediatric patients diagnosed with cancer at northern latitudes

“…Adjusted linear regression indicated that the age, season, and calendar year were significant predictors of lower 25(OH)D levels. The data on 295 patients with leukaemia were previously published elsewhere 13 …”

“…The levels of intact PTH were measured using a two‐site chemiluminescent assay on the Roche Cobas e601 platform (Roche Diagnostics, Penzberg, Germany). Details of the measurements have been reported elsewhere 13 …”

“…We performed statistical analyses for the entire cohort and then separately for preschool children (aged ≤6 years) and school children (aged >6 years). This was done since previous data demonstrated considerable differences in vitamin D status between preschool and school children 13,16,17 . Statistical analyses were performed using SPSS version 26 (IBM Corporation, New York, USA).…”

“…We have previously reported that one‐third of paediatric patients with leukaemia treated at our hospital had vitamin D levels below 50 nmol/L at the time of diagnosis. Older age, season outside summer, acute myeloid leukaemia and more recent calendar year were associated with lower 25‐hydroxyvitamin D (25(OH)D) levels 13 . Data on the vitamin D statuses of children living in Sweden with other cancer diagnoses are unavailable.…”

Prevalence of Osteopathologies in Children and Adolescents After Diagnosis of Acute Lymphoblastic Leukemia

“…In addition, the hormone vitamin D plays an important role in the maintenance of calcium homeostasis and thereby bone health in childhood and adolescence (21). Given its additional functions such as regulation immunity and cellular differentiation, an optimal vitamin D status may be important especially for patients with cancer (22). Therefore, the assessment of bone health in a population at risk for bone disease should account for all of the above.…”